Healthcare Provider Details

I. General information

NPI: 1942279278
Provider Name (Legal Business Name): PHARMACEUTICAL CONCEPTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6102 BANKS ST
LULA GA
30554-5114
US

IV. Provider business mailing address

PO BOX 436
LULA GA
30554-0436
US

V. Phone/Fax

Practice location:
  • Phone: 770-869-3616
  • Fax: 770-869-9080
Mailing address:
  • Phone: 770-869-3616
  • Fax: 770-869-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE006369
License Number StateGA

VIII. Authorized Official

Name: AMY MILLER
Title or Position: PIC
Credential: BS PHARMACY
Phone: 770-869-3616